Abstract
A 19-year-old man was born with T12 myelomeningocele. He had undergone leR ureteral reimplantation a t age 1 year and numerous surgeries common for this condition, including placement of posterior spinal fixation rods (Luque rod) for correction of scoliosis in 1986 and 1994, and placement of an artificial urinary sphincter in 1987. He performed clean intermittent catheterization 4 times daily and was compliant with this regimen. Followup consisted of stable urodynamics and renal ultrasound. The patient was well until 1996, when recurrent urinary tract infections and bilateral hydronephrosis developed. Urodynamic studies demonstrated a hypertonic bladder (46 cm. water at 206 cc) while on maximal anticholinergic therapy. An ileal augmentation cystoplasty was performed in January 1997. After augmentation the hydronephrosis progressed, primarily on the right side. Voiding cystourethrography demonstrated no reflw and urodynamic studies indicated adequate compliance (41 cm. water at 540 ml.). A diuretic quantitative renal scan demonstrated 80% split function on the right side with a prolonged half-time drainage curve. A right percutaneous nephrostomy tube was placed and an antegrade nephrostogram demonstrated obstruction of the right distal ureter a t the level of the Luque rod (fig. 1). A preoperative Whitaker antegrade perfusion study demonstrated a pelvic pressure of 38 cm. water, compared to a
Published Version
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